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Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis

Systematic Reviews volume 14, Article number: 32 (2025) Cite this article

Abstract

Background

Insufficient lactation, known as hypogalactia, is an important reason for weaning. To date, no effective methods have been established to increase lactation volume. With the advantages of low cost and convenience, acupoint stimulation—defined as any stimulation applied at acupoints—is a promising option.

Objectives

The aim of this systematic review was to evaluate the effectiveness of acupoint stimulation for postpartum breastfeeding insufficiency.

Methods

A systematic search of seven databases (PubMed, MEDLINE, Embase, Cochrane, CNKI, Airiti Library, ClinicalTrials.gov) was performed from their inception dates to September 30, 2023. Randomized trials were included. The inclusion criteria of the intervention included acupuncture, acupressure (including tuina and massage), electroacupuncture, laser stimulation, catgut embedding, and auriculotherapy. The primary outcomes were the amount of lactation and the level of prolactin. Secondary outcomes were colostrum time and adverse effects. The risks of bias were assessed using RoB 2.0.

Results

Twenty-four studies involving 3214 participants were included. When compared to the control group, the experimental group exhibited improved volume of milk production (MD = 81.30; 95% CI = 58.94–103.67) and higher prolactin levels (MD = 41.90, 95% CI = 28.57–55.22). Colostrum time was shorter in the control group ([MD = − 7.26; 95% CI = − 10.69 to − 3.83] for continuous data; [RR = 1.70; 95% CI = 1.38–2.08] for dichotomous data). Adverse effects were reported in only one trial, which included three cases of fear of acupuncture and one case of hypotension.

Conclusions

Acupoint stimulation may have beneficial effects on postpartum breastfeeding insufficiency. However, the results should be interpreted with caution because of the presence of risks of bias and heterogeneity among studies.

Peer Review reports

Introduction/background

The World Health Organization (WHO) and the American Academy of Pediatrics (AAP) recommend exclusive breastfeeding for the first 6 months after birth and continuous breastfeeding with other complementary food up to 2 years of age [1]. Exclusive breastfeeding has a lot of benefits for the mother’s health, the baby’s health, and the economy. On one hand, breastfeeding is associated with lower risk of diarrheal diseases, respiratory infections, otitis media, and childhood obesity in infants [2]. On the other hand, breastfeeding might also reduce risk of excessive postpartum bleeding in mothers and aid in their rapid return to prepregnancy levels of fitness and health. Over the long term, breastfeeding has the potential to decrease the risk of developing ovarian cancer, breast cancer, and diabetes mellitus [3, 4]. Breastfeeding has economic importance in reducing hospital expenses for diseases, such as necrotizing enterocolitis, infection of the respiratory tract and gastrointestinal tract, sudden infant death syndrome, atopic dermatitis, and asthma [5]. The United States could save more than 13 billion dollars and prevent over 900 deaths if 90% of mothers followed the recommendation of exclusive breastfeeding for the first 6 postpartum months [2]. Factors influencing lactation volume include stress, fluid absorption, breast surgery history, maternal hormone levels, and parity [6]. Common reasons for early weaning include low milk supply, pain, and mastitis. Approximately, 20 to 30% of mothers cease exclusive breastfeeding due to postpartum breastfeeding insufficiency [7,8,9,10].

Pharmaceutical and complementary interventions are used to elevate the volume of human milk production. Medical methods include dopamine antagonists, which are the most commonly used galactagogues. Domperidone has been reported as an effective agent, but it has been associated with potentially serious side effects, such as palpitations and arrhythmias [11, 12]. Recombinant prolactin has potential in facilitating breastfeeding, but it is expensive [13, 14]. Most galactagogues are not recommended for routine use because of limited evidence of efficacy, as well as safety concerns [15]. Regarding nonmedical approaches, two notable interventions are Okeya’s method, also referred to as Oketani’s method, and acupoint stimulation. Okeya’s method involves a combination of massage and feeding techniques [16,17,18]. However, there is limited information available in terms of evidence related to Okeya’s method. Currently, there is a lack of widely reported evidence-based approaches for managing breastfeeding insufficiency.

Acupoint stimulation is defined as any stimulation at acupoints. Three prior systematic reviews have examined acupoint stimulation as a treatment for breastfeeding insufficiency [19,20,21]. However, none of these systematic reviews conducted meta-analysis, and the inclusion of trials was limited. The effect of acupoint stimulation remains uncertain. Therefore, this systematic review and meta-analysis aimed to evaluate the effectiveness of acupoint stimulation for postpartum breastfeeding insufficiency.

Material and methods

The protocol of this review was registered in PROSPERO (CRD42022373785). The review was reported according to the checklist of Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) [22].

Search strategy

We extensively searched the following database from their inception dates to September 30, 2023: PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure (CNKI), the Airiti Library, and ClinicalTrials.gov. We also searched reference lists of relevant papers to identify additional trials. We used MeSH terms (lactation, milk secretion, hypogalactia, acupuncture, acupressure, moxibustion, massage, and tuina) in the literature search. We did not apply any language limitations. We presented the literature search strategy in Additional file 1: Table S1.

Selection criteria and exclusion criteria

Inclusion criteria

  1. 1.

    Types of studies: Randomized controlled trials (RCTs) were included.

  2. 2.

    Types of participants: Mothers who had delivered at any gestation were included. There was no limitation on the type of delivery, such as vaginal delivery or a cesarean delivery.

  3. 3.

    Types of intervention: For the experimental group, acupoint stimulation refers to all kinds of methods stimulating acupoints in the body. Acupuncture, electroacupuncture, acupressure, low-level laser, moxibustion, catgut embedding, auriculotherapy, and ear acupressure were all included. For the control groups, routine nursing care refers to the usual postpartum care and other basic methods promoting breastfeeding. Psychological care, feeding posture guidance, dietary advice, and provision of a comfortable environment were all involved.

  4. 4.

    Types of outcome measures: The primary outcomes were the volume of milk production and the serum prolactin level. The secondary outcomes were colostrum time and adverse effects.

    1. 1)

      The increased production of prolactin, a hormone that stimulates the mammary glands to produce milk after childbirth, is among the prerequisites for lactation. However, the prolactin level fluctuates extensively with diurnal variability, being correlated with the suckling. The normal range of prolactin in nonpregnant women and pregnant women is less than 25 ng/ml and 80 to 400 ng/ml, respectively. Although prolactin is critical for breast milk production, the absolute levels of prolactin required for adequate lactation remain unknown [23].

    2. 2)

      Colostrum time was defined as the interval to the initiation of milk secretion after the expulsion of the placenta. The standard unit of measurement is “hour.”

    3. 3)

      Adverse effects included undesirable sensations or feelings among the participants and abnormal laboratory data (blood cell count or any findings indicating organ damage).

Exclusion criteria

Observational studies and reviews were excluded. Trials that compared the different forms of acupoint stimulation and that compared acupoint stimulation with medicine were excluded. Trials that involved women with a diagnosis of mastitis or acquiring breast disease were excluded. Women who had serious diseases—such as cancer, liver disease, kidney disease, or psychosis—were excluded. Studies with insufficient original data were also excluded.

Data extraction and quality assessment

After the exclusion of duplicate studies, two independent researchers screened the titles and abstracts of the articles for the first exclusion. Then, the full texts of the selected articles that potentially met the eligibility criteria were reviewed. We resolved any disagreement through discussion or consulted the third review author. We extracted data using a predefined data collection form. The information included the age ranges of the participants, details about the interventions, and descriptions of the outcomes. Two independent researchers evaluated the methodological quality of the included studies using the Cochrane risk-of-bias tool (RoB 2.0) [24]. RoB 2.0 consists of five domains, including bias from the randomization process (allocation), bias from the intended interventions (performance), bias from missing outcome data (follow-up), bias from the outcome measurement (measurement), and bias from the selection of the reported results (reporting). The authors rated five domains, abbreviated to allocation, performance, follow-up, measurement, and reporting, as either low risk, some concerns, or high risk. Each result was rated separately. Any disagreement was resolved through discussion or by involving a third assessor.

Statistical analyses

All analyses were performed using Review Manager (RevMan 5.3) and Comprehensive Meta-Analysis version 4 software. For continuous data, the mean difference (MD) was used to combine trials measuring the same outcome in the same unit. Dichotomous data were compared as odds ratios/risk ratios (ORs/RRs). Since statistical heterogeneity was anticipated, we applied a random-effects model to the meta-analysis. Heterogeneity among the trials was assessed by means of p-values, I2 statistics, and chi-square statistics and was regarded as substantial if p < 0.10 and I2 > 50. Additionally, a funnel plot and Egger’s test were used to investigate the publication bias. Subgroup analyses were conducted to examine the effects of different types of acupoint stimulation and to address the heterogeneity. The studies were categorized into three subgroups: acupuncture, acupressure, and auriculotherapy. Sensitivity analysis was performed to test the stability of the results. Meta-regression was conducted to identify the sources of heterogeneity.

GRADE assessment

The quality of the evidence was assessed by the GRADE approach (GRADEpro) [25], using five considerations (study limitations, consistency of effect, imprecision, indirectness, and publication bias) to assess the quality of the body of evidence for each outcome. The evidence would be downgraded from “high quality” by one level for a serious limitation or even two levels for a very serious limitation.

Results

Study selection and characteristics

The selection process is shown in Fig. 1. (The details of search strategies are listed in the appendix [see Additional file 1: Table S1]). Database searches yielded 649 studies from the above 7 databases. Excluding the duplicates, there were 368 reports. Then, the title, abstract, and context for eligibility were screened. Four studies were found from reference lists. Finally, a total of 24 studies were included, comprising 3214 women.

Fig. 1
figure 1

PRISMA flow diagram

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The full details of the 24 included studies are presented in Table 1. The ages of the participants ranged from 18 to 45 years. Most trials were conducted in China, except for the studies conducted by Esfahani et al. in Iran [26], Maged et al. in Egypt [27], Suwikrom et al. in Thailand [28], and Neri et al. in Italy [29]. The duration of the intervention ranged from 2 days to 1 month. In this systematic review, the most common acupoints used for breastfeeding insufficiency were ST18, ST36, RN17 (CV17), and SI1.

Table 1 Characteristics of included studies
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Quality assessment

The risks of bias were evaluated using RoB 2.0, with the signaling details provided in Table S2 ([see Additional file 1]). The double-blind study was not performed due to the characteristics of the intervention. The methodological qualities of the included trials are summarized in Figs. S1, S2, S3, and S4 (in the appendix [see Additional file 1]). Overall, the risk of bias in the included studies was primarily some concerns, and the bias was mainly from outcome measurements. More details were provided in the description of each different outcome.

Clinical outcomes

Volume of milk production

Among 20 studies [26, 28, 31,32,33,34,35,36,37,38, 40,41,42,43,44,45,46,47,48,49] that reported on the volume of milk production, only the raw data from 9 studies [26, 28, 33,34,35, 37, 38, 42, 46] could be used for the meta-analysis because the other 11 studies [31, 32, 36, 40, 41, 43,44,45, 47,48,49] lacked sufficient raw data for comparative analyses.

These nine studies reported post-intervention differences in milk production volume. In increasing milk production, acupoint stimulation was superior to routine nursing in all nine studies (MD = 81.30; 95% CI = 58.94–103.67; I2 = 99%) (Fig. 2). A random-effect model was employed owing to the heterogeneity (I2 = 99%, P < 0.00001).

Fig. 2
figure 2

Forest plot of comparison: volume of breast milk production

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We conducted two subgroup analyses: one based on the type of acupoint stimulation (Fig. 2) and the other on varying duration of the interventions (Fig. S5 in the appendix [see Additional file 1]). In the subgroup analysis of different intervention types, significant effects were detected across all subgroups (acupuncture [MD = 90.90; 95% CI = 11.44–170.36; I2 = 98%], acupressure [MD = 29.20; 95% CI = 7.92–50.48; I2 = 99%], and auriculotherapy [MD = 445.90; 95% CI = 396.39–495.41]).

In the subgroup analysis based on intervention duration, significant effects were observed across all subgroups: for interventions lasting 3 days or less (MD = 15.94; 95% CI = 13.75–18.13; I2 = 0%), for interventions lasting more than 3 days but not exceeding 7 days (MD = 175.29; 95% CI = 79.87–270.72; I2 = 99%), and for interventions exceeding 7 days (MD = 71.69; 95% CI = 8.93–134.45; I2 = 99%).

We explored the effect of trial quality on poor-quality studies being excluded from the analyses in order to assess whether any difference would be made to the overall result. By excluding Li et al. (2014) [33], the result remained the same in the volume of lactation (Fig. S6 in the appendix [see Additional file 1]).

Regarding the other 11 studies [31, 32, 36, 40, 41, 43,44,45, 47,48,49], we conducted a qualitative analysis. A notable concern in many of these studies was the risk of bias in outcome measurement, primarily attributable to the use of subjective diagnostic criteria [32, 40, 43, 47]. Most trials revealed significant increases in the volume of milk production, except for the study by Zhu Ailing et al. (2018) [47]. Zhu Ailing et al. (2018) reported no significant difference in the volume of milk production between the experimental and control groups in the first 3 days; however, there was a significant intergroup difference after 3 days.

Prolactin level

In 12 studies [27, 30, 36,37,38, 41,42,43,44, 46,47,48], serum prolactin levels (ng/ml) were utilized as an outcome measure. The overall effect demonstrated positive and statistically significant change (MD = 41.90, 95% CI = 28.57–55.22; I2 = 98%) (Fig. 3). Within the subgroup analysis, the effect was positive and significant in the acupressure subgroup (MD = 40.19, 95% CI = 9.94–70.44; I2 = 99%). In the subgroup of acupuncture (MD = 50.28, 95% CI = − 6.99 − 107.54; I2 = 86%) and auriculotherapy alone (MD = 77.34, 95% CI = − 10.05 − 164.74; I2 = 92%), the results did not reach statistical significance. A random-effect model was employed because of the observed heterogeneity.

Fig. 3
figure 3

Forest plot of comparison: prolactin level

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The risks of bias for the included studies were some concerns predominantly [27, 30, 36,37,38, 41,42,43,44, 46,47,48]. However, there were allocation bias, attribution bias, and reporting bias in Zheng et al. [44]. The bias was mainly from the difference in the number of participants and unclear data on prolactin levels. We also performed sensitivity analysis by excluding Zheng et al. (2012), and the result remained the same in the level of prolactin (Fig. S7 in the appendix [see Additional file 1]).

Colostrum time

Among eight studies [32, 34, 36, 38, 40, 43, 44, 47] that evaluated colostrum time, four studies put the data into groups. Therefore, dichotomous and continuous data were both in the outcome of colostrum times. In the dichotomous outcome, if colostrum occurs in less than 24 h, it is defined as an event. Meta-analyses were performed separately in the dichotomous data (colostrum occurs in less than 24 h) and in the continuous data of colostrum time. Seven studies [32, 34, 36, 38, 40, 44, 47] compared acupressure with control, and the other one [43] compared auriculotherapy with control. For continuous outcome, four studies [34, 38, 44, 47] were included in the meta-analysis. Statistical difference was revealed between the experimental group and the control group (MD = − 7.26; 95% CI = − 10.69 to − 3.83; I2 = 95%) (unit: hour) (Fig. 4). For the other four trials involving dichotomous data [32, 36, 40, 43], the data pertained to the number of individuals whose colostrum production occurred within 24 h. Colostrum time within 24 h refers to the initiation of milk production within 1 day following the delivery of the placenta. Compared with that of controls, the colostrum time of the acupoint stimulation group was shorter (RR = 1.70; 95% CI = 1.38–2.08; I2 = 55%) (Fig. 5).

Fig. 4
figure 4

Forest plot of comparison: colostrum time

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Fig. 5
figure 5

Forest plot of comparison: colostrum occurs in less than 24 h

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Safety

Six studies [29, 31, 37, 39, 42, 46] documented the incidence of adverse events. Most of the studies reported no adverse effects [31, 37, 39, 42, 46]. No abnormalities in the blood (including kidney function and liver function), urine, or stool data were reported. Only Neri et al. mentioned that three women were afraid of acupuncture, and one woman had hypotension after acupuncture [29].

Funnel plot of publication bias

We investigated publication bias using funnel plot (Fig. 6) and Egger’s test. The outcome selected for the funnel plots was the prolactin level, as it involved 12 trials [27, 30, 36,37,38, 41,42,43,44, 46,47,48]. It is important to note that funnel plot might have limited power to detect bias if there were fewer than ten trials included [50]. Because only nine trials were included in volume of milk production, the other main outcome, funnel plot of it was not performed. Egger’s test of volume of milk production yielded a p-value greater than 0.05, suggesting no significant publication bias (p = 0.00296). Conversely, Egger’s test for prolactin levels resulted in a p-value less than 0.05, indicating possible presence of publication bias (p = 0.00593).

Fig. 6
figure 6

Funnel plot of comparison: prolactin level

Full size image

Meta-regression analysis for heterogeneity

To further investigate heterogeneity within our study, meta-regression analysis was conducted. Covariates such as the year of publication, sample size, and study duration did not show a statistically significant effect on the outcome (Table 2). The covariate “risk of bias” (1 means low risk, 2 means moderate risk, 3 means high risk) significantly influenced the outcomes regarding lactation volume.

Table 2 Univariate random-effects meta-regression analysis for heterogeneity by various covariates
Full size table

GRADE assessment

We assessed quality of evidence by using GRADEpro [25] with the data from forest plot. Based on the GRADE criteria, the quality of the evidence for the majority of indicators (volume of milk production and prolactin level) was low (Table 3). As for the colostrum time, the data quality was very low. In the certainty assessment, we incorporated the concept of the minimally important difference (MID) when evaluating imprecision. When analyzing continuous data such as volume of milk production and prolactin levels, which involved more than 400 participants, we did not find significant concerns regarding imprecision. However, for the colostrum time, which had a smaller sample size of only 304 participants, we identified a substantial issue with imprecision. Regarding the dichotomous outcome, we determined that there were concerns with imprecision for colostrum time (in group) because the small sample size and the confidence interval for the risk ratio surpassed 1.25, which served as the threshold for minimally important difference.

Table 3 GRADE profile for postpartum breastfeeding insufficiency
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Discussion

The aim of this systematic review and meta-analysis is to assess the efficacy of acupoint stimulation for postpartum breastfeeding insufficiency. This result revealed that acupoint stimulation had a positive effect on postpartum breastfeeding insufficiency in terms of lactation volume, prolactin level, and colostrum time but with low or very low certainty of evidence. Adverse events were rare, and only one case of hypotension was mentioned in the experimental group.

Most clinical trials showed positive evidence of acupoint stimulation. In three previous related systematic reviews [19,20,21], all included trials were conducted before 2018, and the numbers of included trials were small. No meta-analysis has been performed before. Besides, Anderson et al. set search limits by language [20]. However, relevant studies have been reported in recent years, and the generation of up-to-date evidence is warranted. Boram et al. presented evidence that was consistent with the findings of our analysis; auriculotherapy showed positive effects on increasing the volume of milk production as well as serum prolactin level and facilitating the onset of lactation [19]. Our analysis also demonstrated a significant increase in lactation volume associated with auriculotherapy. Similarly to Anderson et al., our meta-analysis demonstrated acupressure to be associated with benefits in milk production [20]. In our subgroup analysis, the acupuncture subgroup had an increased effect size and reduced heterogeneity compared to the acupressure subgroup. Acupuncture involves direct fine needle insertion, potentially contributing to a greater level of stimulation than acupressure. Similar result in the subgroup analysis was also showed in another systematic review about acupoint stimulation in cancer pain control [51]. Previous studies have shown that acupuncture at specific acupoints activates distinct autonomic pathways for treating specific diseases by bioelectronic stimulation [52]. The depth and intensity of stimulation influence the types of afferent nerve and thus contribute to the effect [53]. Our analysis confirms that very few adverse events were presented, which is similar to the findings from the three previous related systematic reviews. The meta-analysis study provides more up-to-date evidence to support the benefits of acupoint stimulation in lactation.

Few articles have clearly indicated the potential mechanism of acupoint stimulation for lactation because of the vulnerability of infants and postpartum women. An animal experiment revealed that electroacupuncture at SP6 and ST36 affected the activity of the hypothalamus-pituitary-ovary axis [54, 55] and thus influenced hormones, including GnRH, FSH, LH, and estradiol. After the delivery of the placenta, progesterone levels decreased and relieved the inhibitory effect on prolactin, while the prolactin level increased and triggered lactation [56]. Therefore, our findings support the hypothesis that acupoint stimulation has a positive effect on lactation by affecting the hypothalamus-pituitary-ovary axis.

In traditional Chinese medicine, breastfeeding insufficiency is often attributed to a deficiency of Qi (vital energy) and blood or stagnation of the liver Qi. The nipple belongs to the liver channel, and the breast belongs to the stomach channel. Acupoint stimulation on the liver and stomach channels could regulate Qi and blood. Common acupoints found in our systematic review—such as ST18, ST36, and LR3—are located in the stomach meridian and liver meridian. Auriculotherapy, as a noninvasive procedure, is also capable of regulating visceral function [46].

Traditional Chinese medicine and acupuncture have been used around the world. The concepts of meridian and acupoints have also been widely accepted. The experience summarized in this systematic review could inspire healthcare providers.

The limitations of this systematic review involved several aspects, including the risks of bias, heterogeneity, and low certainty of evidence. First, this systematic review and meta-analysis included several trials with small sample size. Second, some studies grouped the outcome into many levels and thus making it difficult to pool data for the meta-analysis. Besides, the heterogeneity of the included trials was high.

Although the treatment courses, intervention duration, types of intervention, and acupoints varied from trial to trial, we used a random-effects model in the meta-analysis.

Future research should focus on the effective acupoints and the effective duration of intervention when people conduct studies investigating acupoint stimulation for postpartum breastfeeding insufficiency.

Conclusion

This systematic review revealed the beneficial effects of acupoint stimulation in the treatment of postpartum breastfeeding insufficiency. Acupoint stimulation could elevate milk production volume and shorten colostrum time with no safety concerns. However, the results should be interpreted with caution because of the quality of the included studies and the low or very low certainty of evidence.

Abbreviations

AAP:

American Academy of Pediatrics

C-section:

Cesarean section

CNKI:

China National Knowledge Infrastructure

RoB 2.0:

Cochrane risk-of-bias tool 2.0

CG:

Control group

EG:

Experimental group

FSH:

Follicle-stimulating hormone

LH:

Luteinizing hormone

LQS:

Liver Qi stagnancy

MD:

Mean difference

N/A:

Not available

OR:

Odds ratios

PRISMA:

Preferred Reporting Items for Systematic reviews and Meta-Analysis

QBD:

Qi-blood deficiency

RCT:

Randomized controlled trials

RR:

Risk ratios

RevMan 5.3:

Review Manager

SMD:

Standardized mean difference

US:

United States

VAS:

Visual analogue scale

WHO:

World Health Organization

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Acknowledgements

We thank all for their contribution and support to the accomplishment for this research.

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Authors and Affiliations

  1. Linkou Chang Gung Memorial Hospital, No. 5, Fuxing St., Taoyuan City, Guishan Dist., 333, Taiwan (R.O.C.)

    Ya-Ching Chang

  2. Cathay General Hospital, No. 280, Sec. 4, Renai Rd., Taipei City, 106438, Taiwan (R.O.C.)

    Yi-An Wang

  3. Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Keelung, No. 222, Maijin Rd., Anle Dist., Keelung City, 204201, Taiwan (R.O.C.)

    Zi-Yu Chang & Jian-An Liao

  4. Graduate Institute of Clinical Medical Sciences, Chang Gung University, No. 259, Wenhua 1 Rd, Taoyuan City, Guishan Dist., 33302, Taiwan (R.O.C.)

    Jian-An Liao

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Contributions

YCC conceived the article, drafted the research protocol, retrieved the literature, analyzed the data, and wrote this manuscript. YAW and JAL screened studies and evaluated risk of bias. YCC and YAW extracted data and gave suggestions for the discussion. YCC and JAL analyzed the data. JAL gave suggestions on the structure of the article. ZYC and JAL provided methodological guidance and gave suggestions on the conception of the article. All authors have read and approved this manuscript.

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Correspondence to Jian-An Liao.

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Supplementary Information

13643_2025_2773_MOESM1_ESM.pdf

Additional file 1: Appendix: Table S1. Literature search strategy. Figure S1. Risk of bias graph: review authors’ judgements about each risk of bias item (RoB 2.0) presented as percentages across all included studies. Figure S2. Methodological quality summary: review authors’ judgements about each methodological quality item for each including study (Milk volume). Figure S3. Methodological quality summary: review authors’ judgements about each methodological quality item for each including study (Prolactin level). Figure S4: Methodological quality summary: review authors’ judgements about each methodological quality item for each including study (Colostrum time). Figure S5. Subgroup analysis of volume of breast milk production (by duration of the intervention). Figure S6. Sensitivity analysis of volume of breast milk production. Figure S7. Sensitivity analysis of prolactin level. Table S2. Risk of bias judgement: N no, NI no information, PN probably not, PY probably yes, Y yes; ITT Intent-to-treat, PP Per-Protocol.

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Chang, YC., Wang, YA., Chang, ZY. et al. Acupoint stimulation for postpartum breastfeeding insufficiency: a systematic review and meta-analysis. Syst Rev 14, 32 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s13643-025-02773-8

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Keywords

Systematic Reviews

ISSN: 2046-4053